Semi Annual Safeguard Monitoring Report

Semi Annual Safeguard Monitoring Report Project Number: SRI 51107 -002

ADB Loan and Grant Numbers – SRI 3727 and SRI – 0618

Reporting Period: 1 January to 30 June 2021

Sri Lanka: Health System Enhancement Project

(HSEP)

Prepared by HSEP (Health System Enhancement Project) Project Management Unit for the

Ministry of Health and Indigenous Medical Services (Former named as “Ministry of Health Nutrition

and Indigenous Medicine”), Colombo, Sri Lanka.

This social monitoring report is a document of the borrower. The views expressed herein do not

necessarily represent those of ADB’s Board of Directors, Management, or staff, and may be

preliminary in nature.

In preparing any country program or strategy, financing any project, or by making any designation

of or reference to a particular territory or geographic area in this document, the Asian

Development Bank does not intend to make any judgments as to the legal or other status of any

territory or area.

Health System Enhancement Project – Semi - annual Social Safeguard Monitoring Report 2021

i

GOVERNMENT OF SRI LANKA

MINISTRY OF HEALTH

SEMI ANNUAL SOCIAL SAFEGUARD

MONITORING REPORT 2021

June 2021

HEALTH SYSTEM ENHANCEMENT PROJECT ADB Loan and Grant Numbers – SRI - 3727 and SRI – 0618

Project Management Unit

19/3, Kynsey Road, Colombo 8, Sri Lanka


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ABBREVIATIONS

ADB Asian Development Bank

BOQ Bill of quantity

DDRs Due diligence reports

DH District hospital

EA Executing agency

GDP Gross domestic product

GIS Geographic information system

GRC Grievance redress committee

GRM Grievance redress mechanism

IP Indigenous people

IPP Indigenous people’s plan

IPPF Indigenous people’s planning framework IR

Involuntary resettlement

LAA Land Acquisition Act

LAR Land acquisition and resettlement

MOHNIM Ministry of Health, Nutrition and Indigenous Medicine

NIRP National involuntary resettlement policy

PHC Primary health care

PIU Project implementation unit

PMCU Primary medical care unit

PMU Project management unit

PPTA Project preparatory technical assistance

PSGA Poverty social and gender analysis

SIA Social impact assessment

SPO Sub project office (of design and consultancy firm) SPS

Safeguard policy statement


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Table of Contents

SEMI ANNUAL SOCIAL SAFEGUARD MONITORING REPORT 2021 ................................... i

ABBREVIATIONS ......................................................................................................................... ii

01. EXECUTIVE SUMMARY ....................................................................................................... v

02. BACKGROUND OF THE REPORT AND PROJECT DESCRIPTION ................................... 1

03. PROJECT OBJECTIVE AND EXPECTED OUTCOMES ...................................................... 2

04. INSTITUTIONAL FRAMEWORK FOR PROJECT PLANNING AND IMPLEMENTATION

................................................................................................................................................... 3

05. SCOPE AND PRESENT PROGRESS OF CIVIL WORKS .................................................... 3

06. SCOPE OF IMPACTS AND IMPACTS OBSERVED DURING REPORTED PERIOD ....... 5

07. COMPENSATION AND REHABILITATION ....................................................................... 9

08. PROJECT DISCLOSURE, PUBLIC PARTICIPATION AND CONSULTATION ................ 9

09. IMPLEMENTATION OF GENDER ACTION PLAN ........................................................... 10

10. GRIEVANCE REDRESS MECHANISM (GRM) ................................................................. 10

11. IMPLEMENTATION OF FUNCTIONS OF PMCUs ............................................................. 11

12. INSTITUTIONAL ARRANGEMENTS AND TRAINING ................................................... 12

13. CONCLUSION AND RECOMMENDATIONS ..................................................................... 20

14. ACTIVITIES PLANNED UNDER SOCIAL SAFEGUARD COMPONENT OF THE

PROJECT ................................................................................................................................ 21

Annex 1- Detailed observation of field visits during January to June 2021 .................................. 22

Annex 2- Information provided by M&E officers in each PIU ..................................................... 32


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Table 1 - Progress of construction and social issues if any under round 1 ................................ 4

Table 2 - Progress of Design preparation on round 2 sub-projects by 30.06.2021 .................... 4

Table 3 - Summary of Social safeguard observation in Monaragala sub projects ................... 6

Table 4 - Summary of Social safeguard observation in Matale & Kegalle sub projects .......... 7

Table 5 - Procedures adopted by the contractors and action taken with regard to COVID 19 13

Table 6 - covenants - as per legal agreements ............................................................................. 17

Table 7 - Activities planned in the 2nd 6 months of 2021 ........................................................... 21

Table 8 - Observations in subprojects visited during in January 2021 – Monaragala district 22

Table 9 - persons consulted – Monaragala District ..................................................................... 25

Table 10 - Observations in subprojects visited during in April 2021 – Matale district .......... 26

Table 11 - Persons consulted 2021 – Matale district .................................................................. 28

Table 12 - Observations on Kegalle District during April 2021 ................................................. 29

Table 13 - Persons consulted 2021 – Kegalle district ................................................................. 31

Table 14 - Social Issues emerged in hospitals/health care centers under round 1.................... 32









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01. EXECUTIVE SUMMARY

I. This Semi-Annual Social Safeguards Monitoring for Health System Enhancement Project (HSEP)

of Sri Lanka covers the period from January to June 2021. The results of the Due Diligence Reports

(Social Safeguard) prepared for the proposed project concluded that, as per ADB Safeguard

Policy Statement, the project is categorized as ‘C’ for both Involuntary Resettlement and

Indigenous Peoples. The areas of development within the four provinces (Central, North

Central, Uva and Sabaragamuwa provinces) were selected based on identification of critical gaps

with a geographic targeting to ensure coverage of lagging regions. It has been found that no

additional land is required for the project. The land identified for locating all facilities are belong

to respective institution without acquiring private lands. Therefore, no either resettlement impacts

or temporary disruption of livelihood of any household or group of community in the project area

during design and construction periods. Hence, it can be concluded that the project activities

conducted during the reporting period does not have any involuntary resettlement issues.

II. All the project activities comply with the concerned laws and regulations of Sri Lanka. The

screening of the project sites and the preparation of DDR-Social was based on the, ADBs

Safeguard Policy Statement 2009.The project output indirectly contribute to gender equality and

gender responsiveness.

III. Public consultations have been carried out during planning and implementation phases of the

project. The views raised at the consultation were incorporated in the design. Issues raised are

being addressed during the implementation phase to ensure that the stakeholders are not affected

adversely by implementation of the project.

IV. During the reporting period the social safeguard expert visited 24% of subprojects covering as

sample of subprojects implemented in round 1 and 2 in Uva, Central and Sabaragamuwe provinces.

The sample subprojects are representative civil works undertaken in HSEP. Supplementary data

on social safeguard issues cropped up if any in all 4 provinces was obtained from M&E Officers in

each PIU. Therefore, this report covered all the subprojects implemented under round 1 and 2.


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02. BACKGROUND OF THE REPORT AND PROJECT DESCRIPTION

2.1 Objective of the report

01. This Semi-Annual Social Safeguards Monitoring Report for the Health System Enhancement

Project of Sri Lanka covers the period from 1st January to 30th June 2021. The objective of the

report is to provide an overview of the progress made in the implementation of the Social Safeguard

activities during this reporting period. It provides information on social safeguards activities related

DDRs, GAP implementation and social as well as safeguards issues raised during the design and

construction periods, as needed as well as social impact mitigation measures adopted. It describes

the project’s performance in dealing with community consultation and stakeholders’ participation

and grievances received and redressed. Lessons learned and the recommendations for the

implementation of safeguards component of the project during the next reporting period are

summarized at the end of the report.

2.2 Project Description

02. The proposed project focuses on strengthening primary healthcare in four underserved provinces

in Sri Lanka – Central, North Central, Uva and Sabaragamuwa. It pursues an equity perspective

in planning and delivery of essential primary health services. It intends to further inform and

operationalize government primary health care (PHC) reform initiatives to reduce bypassing of

PHC facilities through the provision of comprehensive services, including non- communicable

diseases, develop a referral system, and functionally integrate preventive and curative services.

Furthermore, the project will target underserved communities’ access to PHC, and address

selected gaps in core public health surveillance in line with the international health regulations

(IHR).

03. The project targets all nine districts in four provinces with a focus on geographically, socially, and

economically-deprived populations. The total population of the project is approximately 7,000,000

which is 33% of the country population (20,300,000). Out of the total population in the targeted

four provinces, approximately 10 % of the population are estate population and 6.5% is urban

while the majority (83.5%) of the population live in rural areas. The total estate sector population

in Sri Lanka is 895,815. The proposed ADB financed project area encompasses 700,000 (78%) of

the total estate population of which a significant number of centers service this population.

04. Projects and programs financed by ADB need to comply with ADB’s safeguard policies as

detailed in the Safeguards Policy Statement (SPS) of 2009. Therefore, sub-projects and

Components eligible for funding under this project will be required to satisfy the ADB’s safeguard

policies, in addition to conformity with environmental legislation of the Government of Sri Lanka.


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03. PROJECT OBJECTIVE AND EXPECTED OUTCOMES

05. The overarching objective is to improve efficiency, equity, and responsiveness of the health

system.

3.1 - Project outputs:

Output 1. Primary Health Care strengthened especially in lagging areas – four target provinces

(Uva, Sabaragamuwa, Central, and North Central)

a. Curative: infrastructure and equipment support for primary medical health centers (PMCUs)

and district hospitals (DHs).

b. Preventive: outreach and mobility support to ‘medical officers of health’ areas (vehicles,

renovation of field centers).

c. Public awareness and behavior change focusing on primary health care (PHC) demand

and utilization.

d. Management Innovation Fund. In the form of block grants to districts to support innovations

in management, organization, and efficiency improvements (support for related central

stewardship and technical support included under output 3).

06. This output supports the development of curative PHC facilities (this includes DHs and

PMCUs). The priority health facilities were identified by a two-stage objective analysis using the

vulnerability index and the GIS tool in consultation with the MOHNIM and the four provinces. In

stage one, the vulnerability index was used to identify the vulnerable population in the target

provinces and the GIS tool linked the nearest PHC to the vulnerable populations. Based on this

calculation, the priority list of PMCUs and DHs that require development was identified. At stage 2,

in discussion with the provinces, the respective districts, and the MOHNIM, two additional criteria,

(i) facility without basic services - water, electricity, sanitation services (ii) any facility that needed

development based on local knowledge and needs were considered to finalize the neediest

15 PMCUs and DHs per district (total 15*9=135) that will be developed under the project.

Output 2. Health and Surveillance Capacity strengthened

a. Health information technology for continuity of care and improved disease surveillance

(review and support for interoperable health facility-level electronic reporting on patient

information and disease surveillance).

b. Surveillance equipment at points-of-entry and for Epidemiology Unit; and possible support for

infrastructure renovation for inbound migrant health assessment.

Output 3. Policy Development and Project Management Support - technical advisory, operational

policies and guidelines for PHC (e.g. Essential Service Package, human resources for PHC);

project management support

Guide lines introduced by health authorities to be followed in construction sites were strictly followed

by the contractors during monitoring period of this report. This situation was observed by the social

safeguard expert in his visits to construction sites during January to July 2021.


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04. INSTITUTIONAL FRAMEWORK FOR PROJECT PLANNING AND IMPLEMENTATION

07. National steering committee has been set up for policy level guidance for the project and to deal with

ADB. Ministry of Health and Indigenous Medicine is the project executing agency and it has

established Project Management Unit with adequate and experienced staff to persons to facilitate and

direct the project implementation in 4 provinces. Project Implementation Units (PIUs) have been

established in each province for project planning and implementation. The PIU is directed by Project

Coordination Committee headed by Chief Secretary of each provincial Cu8cial.

The Project Executing agency has hired a group of individual consultants to provide professional

support for the PMU. Sub-project design preparation and construction supervision are carried out by a

separate consultancy team hired.

05. SCOPE AND PRESENT PROGRESS OF CIVIL WORKS

08. Civil work under the program have focused mainly on expanding facilities within the Outpatient’s

Department (OPD) in Primary Medical Care Units (PMCUs) and Divisional Hospitals, if necessary,

typically adding between 1,000 to 2,000 sq. feet to the existing building footprint within the same

premises depending on the institution’s requirements. Upgrades to OPDs will typically include

new consultation rooms, dressing rooms, and expanding patient waiting areas, addition/renovation of

emergency treatment units (ETU), laboratories, dispensary, drug stores, staff rest rooms and toilets.

Some work could also include minor renovations such as tiling of floors and walls, electrical re-wiring

and lighting, plumbing and repair to toilets and septic systems, fixing ceilings and roofing, new

furniture, lighting, fixtures and other fittings.

09. Rehabilitation work of substantial number of sub-projects under round 1 have been completed during

this period (January to June 2021) as agreed and this was mainly due to effective monitoring of the

construction supervision team and the PIU . Some issues for delays such as variations of the cost

due to some design changes and COVID 19 imposed health risk. The subprojects identified in round

2 are in the process of Design preparation. The data on construction progress of the round 1 sub-

projects including details of social safeguard related issues if any caused for the delays are shown in

table 1.


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Table 1 - Progress of construction and social issues if any under round 1 subproject by 30.06.2021

Province Number of

subprojects

completed

Number of

subprojects

uncompleted

Social issues if any

Central 5 9 No – Subproject on

Dolosbage could not

be started due to

unsuitability of the

land identified for

subproject

implementation. The

original scope of

work has been

changed and work

related to changed

design will be

attended by the

contractor.

Sabaragamuwa 4 - No

Uva 9 1 No

North Central 5 4 No

Source: PIUs in 4 provinces

The data on progress of design completion of subprojects identified in 4 provinces is also

presented in table 2.

Table 2- Progress of Design preparation on round 2 sub-projects by 30.06.2021

Province Number of subprojects

design completed

Number of

subprojects

not design

completed

Social issues if any on

land acquisition and

any other issues

concerned to

stakeholders

Central 14 All sub-projects - None

Sabaragamuwa 4 fully completed,

6 in progress,

Total 10 sub-projects

- None

Uva

Round 2, phase 1;

8 designs completed and

construction in progress.

Design completed and civil

- A land block has been

identified at Batalayaya

as an alternative

subproject to

Wewagama DH,

located in land side


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works temporarily

suspended due to

selection of this hospital

selection of OPD building

at DHB Medagama as

COVID treatment center.

Round 2, phase 2;

5 designs completed and

procumbent process

started.

5 designs and BOQs

completed,

In 1 hospital only design

completed

prone area

North Central

Province

16

5 None

Source: PIUs in 4 provinces

06. SCOPE OF IMPACTS AND IMPACTS OBSERVED DURING REPORTED PERIOD

10. Most physical work associated with project confined within the existing government-owned lands

and avoided involuntary resettlement impacts (land acquisition and physical or economic

displacement of people).

11. The projects output one consists of refurbishment and renovation of PMCUs and DHs which do

not have any significant adverse social impacts. The land identified for locating these facilities are

belong to respective institution without acquiring private lands. The social safeguard expert

observed some problems of renovating Wewegama DH due to land slide issues in its premises.

Therefore, a land block in Batalayaya was selected as an alternative subproject for improvement

under the HSEP. The originally prepared design in Dolosbage hospital in Central province could

not be started due to unsuitability of the land. This subproject will be implemented with change

scope of work in near future.

12. It has been found that no additional land is required for the project. It is confirmed that there is no

any land acquisition or structural damages or livelihood disturbances due to the implementation

of this project. It is also confirmed that there is no presence of Indigenous people in this project

area. Therefore, the findings of this Social Safeguard Monitoring Report confirm the finding of

DDR, as per ADB Safeguard Policy Statement, the project has been categorized as ‘C’ for both

Involuntary Resettlement and Indigenous Peoples. There is no permanent or temporary

disruption of livelihood of any household or group of community in the project area during

construction period, January to June 2021.


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13. The Social safeguard expert of the project visited 15 subprojects mentioned below during

reporting period. According to his observations there were no serious social safeguard related

issues observed except Uyanwatta PMCU in Sabaragamuwa province. In response to this social

issue social safeguard expert prepared a case study highlighting the issues related to the

Uyanwatta PMCU. Summarized details of Uyanwatta and other subprojects visited are shown

below. Further specific details of observations in sub-projects visited during reporting period are

shown in Annex 1

6.1 - Observations of the sociologist

14. The social safeguard expert visited 5 Sub-projects in Monaragala during 12-1-2021 to 13-1-2021. Summary of the observations in each subproject are mentioned in table 3

.

Table 3– Summary of Social safeguard observation in Monaragala sub projects

Date Names of the sub-projects Observations

12-1-2021 Kotiyagala PMCU in Monaragala District. (sub-project under stage 2 round 2)

There will be no Involuntary Resettlement issues (Negative impacts on land and livelihood activities of people). The details of the design may be further explain to the hospital staff.

12-1-2021 Buddama PMCU in Monaragala District ( sub-project under stage 2 round 2)


12-1-2021 Bakinigahawela PMCU in Monaragala District ( sub-project under stage 2 round 2)


13-1-2021 Devatura PMCU in Monaragala District ( sub-project under stage 2 round 2)

There will be no Involuntary Resettlement


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issues (Negative impacts on land and livelihood activities of people). The details of the design may be further explain to the hospital staff.

13-1-2021 Occumpitiya DH in Monaragala District ( sub-project under stage 2 round 2)

There will be no Involuntary Resettlement issues (Negative impacts on land and livelihood activities of people). The details of the design may be further explain to the hospital staff At present some rehabilitation activities are in progress under Government funds in other parts of the hospital. There will be no duplication of works by these two projects.

Source: observations of the Social safeguard experts of the project

15. Rapid surveys were also carried out in 5 hospitals of Matale and another 5 in Kegalle during April 2021. Summary of the observations made in these field visits are mentioned in table 4:

Table 4 - Summary of Social safeguard observation in Matale & Kegalle sub projects

Date Name of the sub-project

Observations

9-4-2021

Paldeniya PMCU- Matale

The construction of new building is in progress, The interviewed stakeholder representatives are satisfied with new building and its designed components. No significant issues were observed as problems to be attended.

9-4-2021

Kalundawe PMCU-Matale

Kalundawe PMCU has been running in a Midwife’s quarters belongs to MOH. All the stakeholders interviewed (hospital staff and patient) highly appreciated the new building being constructed for the PMCU which is at present operating in a small house with various constraints. There were no any other issues to be addressed from the social safeguard point of view.

9-4-2021

Seegiriya District hospital -Matale

New building is being constructed. This will address most of the problems due to inadequate space. The access from existing buildings to the new building is not included in the sub-project design. This has to be improved with funding from the provincial health ministry resources.

9-4- Galewela DH- Existing dental clinic building is being improved to use for OPD and other


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2021 Matale clinical facilities. The dental treatment facility center will be shifted to other suitable place in existing buildings. Some small rehabilitation work has also proposed with other donor funding such as Bikku Ward with possible funding from Dambulla Temple etc. The hospital staff appreciate the improvement work under the ADB funded project but they are also interested to get few other areas such as improvement to MLT Lab, New facility for X ray, and establishment of Mini-theater for minor surgeries etc. Improved under funding from the provincial Government.

10-4-2021

Madawela Ulpotha PMCU-Matale

Inadequate space is the most difficult constraint faced by this PMCU and this problem will be satisfactorily resolved by the proposed sub-project as expected by the Hospital staff. The hospital staff are struggling a lot to manage the ongoing services to be delivered with extremely poor infrastructure facilities in the present buildings. No issues to be attended from the social safeguard point of view were observed during the visit.

20-4-2021

Uyanwatta PMCU- Kegalle

This PMCU was proposed as one of the sub-projects to be improved under Round 1 but civil work could not be initiated due to some ownerships issues of the land block. This problem was analyzed and a report was prepared to ADB for their information to commence civil work. It can be assumed that sub-project can be started in near future.

21-4-2021

Hewadiwela PMCU-Kegalle

New building for the PMCU is being constructed in a government Land plot used for sport activities by villagers. Villagers were the group requested to expand the existing PMCU to improve its infrastructure facilities to enhance the services. A community Base Organization (CBO) in Hewadiwela has made significant attempts at getting this sub-project approved to this area.

21-4-2021

Bolagama PMCU-Kegalle

Inadequate space is the main problem in the existing building. Almost all the inadequacies have been addressed by the new sub-project being implemented. Lack of furniture will be issues in the new buildings with adequate furniture and such needs may be submitted to the relevant authorities of the Health Department in Kegalle. There were no issues observed related to social safeguard.

21-4-2021

Aranayaka DH-Kegalle

A new building with large space has been constructed. According to the hospital staff lot of facilities can be established in this new building. Aranayaka DH is one of the hospitals established in Kegalle district during British administration period. Most of the buildings existing are dilapidated and badly in need of rehabilitation for future use. The Health staff of the hospital appreciate the ADB funded project’s interventions. Further the MO in charge of Aranayaka hospital is of the opinion that needs for rehabilitation of existing dilapidated infrastructure facilities to be taken up with the Health Authorities of Kegalle District.

Source: observations of the Social safeguard experts of the project Note: Divisional hospital of Dolosbage in central province had faced some issues to implement originally prepared design related civil works due to unsuitability of the land. In response to this issue new scope has been proposed and few activities of civil works such as rehabilitation of staff quarters and some wards will be commenced in near future.


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6.2 - The information reported by M&E officers of PIUs in 4 provinces

16. The M&E officers attached to 4 PIUs kept on monitoring the progress of implementation work in all the sub-projects under round 1 and round 2. They have continuously observed the issues related to construction and design preparation including social and environmental issues. Except 1 subproject in Monaragala (Wewegama), 1 in Kegalle (Uyanwatte) and one in Central Province (Dolosbage) Social safeguard related issues were not reported from any of other subprojects. A new land block in Bathalayaya in Monaragala of Uva province was selected as an alternative subproject to address the environmental issue reported from Wewegama Hospital in Uva-Paranagama DSD. High possibility of land slides in Land of Wewegama hospital was observed. Issues related to land ownership was observed in Uyanwatta PMCU in Kegalle of Sabaragamuwe Province and such issues will be resolved by the Health Authority in Kegalle. The ADB and the HSEP planners are keen to implement Designed improvements of Uyanwatta PMCU. Dolosbage subproject was delayed due to unsuitability of the land and therefore, scope of work originally planned has been changed, the project will be implemented based on new scope of work. The information documented by the M&E officers of each province is shown in Annex 2.

07. COMPENSATION AND REHABILITATION

17. The overall project is categorized as ‘C’ for both Involuntary Resettlement and Indigenous

Peoples as per ADB Safeguard Policy Statement. As on date, considering the subprojects

including civil works taken up, there is no land acquisition or resettlement involved in the project

so far. However, the project would report if it encounters any cases of rehabilitation / resettlement in

future.

18. Since all rehabilitation and reconstruction works are carried out at existing premises, (i.e. no land

acquisition is involved) there is no involuntary resettlement involved in the project. Hence, no

compensation or allowances has been required to be provided.

08. PROJECT DISCLOSURE, PUBLIC PARTICIPATION AND CONSULTATION

19. As per ADB approved RF and IPPF, Due Diligence Reports (Social Safeguards) were prepared for

each sub project and approved by ADB. The DDR confirmed that each sub project falls under

“Category C” for both involuntary resettlement and indigenous people safeguards. During the

reporting period (January –July 2021) there has been no resettlement impacts and impacts to

Indigenous people (annex 2- Reports sent by M&E officers of each province).

20. All project details including list of PMCUs, DHs and Field Health Care Centers, Initial Poverty and

Social Analysis and Social Safeguard and Environmental assessments are available to the public on

ADB website and HSHP website www.hsep.lk.

http://www.hsep.lk/


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21. Consistent with National Involuntary Resettlement Policy (NIRP) and ADB’s Safeguard Policy

Statement (2009) (SPS), meaningful consultations were organized. The project hired a social

safeguard expert in July 2020. He is involved in visiting sub-projects depending on the possibility in

the crucial situation of the country due to COVID 19 pandemic. Design preparation and construction

supervisory consultants and Medical Doctors of some hospitals aware of the role of social safe guard

component of the project during planning and construction stage. The Social safe guard expert also

participate progress review meetings held by PMU and used them as opportunity to provide social

safe guard aspects of the project to the key actors of the project including Deputy Project Directors

in each province.

09. IMPLEMENTATION OF GENDER ACTION PLAN

22. The project has been classified effective gender mainstreaming (EGM) as the p r o j e c t outputs are

designed to advance both women’s and men’s access to health services and infrastructure which

in turn would contribute to mainstreaming gender equality. Some interventions include gender

responsive construction features (separate toilets, private examination and changing rooms); gender

responsive and inclusive essential service package; sex-disaggregated data in health information

systems; and trainings for medical officers and PHC staff on gender sensitivity, gender related

policies, and intervention.

23. PMU has appointed Monitoring and Evaluation Consultant to carry out a study to collect data for

performance assessment of hospitals. The M&E consultant is collecting sex disaggregated data to

assess the gender related impacts. the design team of the project has taken action to include

separate female toilets and suitable access facilities for the disable people visiting the improved

hospitals under the project.

24. The Gender Specialist has been appointed to implement GAP. This consultant is in the process of

analyzing the gender related issues that are being addressed under the project.

10. GRIEVANCE REDRESS MECHANISM (GRM)

25. The project established a grievance redress mechanism that is available and accessible to the

community, officials from the government and non-government organizations and all citizens directly

or indirectly affected or influenced by the project interventions. In addition, a grievance redress

mechanism (GRM) is required for addressing grievances related to environment and social issues

related to the project. A well-defined and managed grievance redress process is benefitting the

project implementing teams as well as the communities directly and indirectly influenced or affected

by the project. It helps to address minor disputes before they are elevated to formal dispute resolution

methods by complainants including to the legal system, mediation bodies or members of parliament.

Some issues emerged in Wewagama sub-project in Monaragala, Dolosbage in Central Province and

Uyanwatte in Kegalle were successfully resolved at the PMU and PIU level during this reporting

period.


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26. An effective ADB approved project-specific three tier Grievance Redress Mechanism (GRM) is in

place for timely and sensible hearings and facilitate solutions. The key staff of PMU and the PIUs in

each province is well aware of the Grievance redress mechanism to be followed. The Grievance

Redress Mechanism of the Project is also disclosed on project website www.hsep.lk. The list of

grievances recorded and attended is provided regularly in the quarterly progress reports. There were

no serious grievances at time of the reporting except above mentioned three cases in Wewagama

DH in Monaragala, Dolosbage DH in Cerntral Province and Uyanwatta PMCU in Kegalle.

27. A Grievance Redress Mechanism (GRM) is established in each PIU to receive, evaluate, and

facilitate resolution of the user group’s concerns, complaints, and grievances on the social and

environmental performance of the project. The Grievance Redress Committee (GRC) is also

established with membership of required key staff of the project and other stakeholders. If any

complaint is received, the GRC will meet fortnightly and can invite others to participate in its

discussions as appropriate to the case. The PIU representative will serve as convener and will advise

subproject residents of this modality.

28. A complainant can register grievances in the ‘grievance register book’ maintained in each of the Sub

Project Offices (SPO) of the Design and Supervision Consultancy team. The register will document

(i) date of grievance registered, (ii) name/address of complainant, and (iii) nature of grievance. The

GRC will prepare a written assessment that describes the complaint and confirms whether the

grievance is genuine/valid. A response on the matter will be provided to the complainant within a

fortnight by the PIU.

29. There has been no serious grievance related issues received by the Grievance redress committees

or the staff of PMU, PIU or any responsible staff of the project during 1st of January to 30th of June

2021, except the issues cropped in Wewagama Hospital in Monaragala, Uyanwatte in Kegalle and

Dolosbage in Kandy. This observation is substantiated by the information provided by the M&E

officers of each PIU.

11. IMPLEMENTATION OF FUNCTIONS OF PMCUs

30. The PMU and PIUs have taken necessary actions to continue all health services to the public

without any interruption to PMCUs functions during the project period. Nevertheless, some

disturbances to the existing functions in OPD areas were observed during the visits of social

safeguard expert to 15 sub-projects during January and April 2021. These disturbances were

experienced by both hospital staff and the patients visiting for treatments. The hospital staffs

have made alternative arrangements to optimize the use of available area within the hospital

premises to minimize these disturbances to the users of the available spaces in the hospital.

However, these temporary disturbances are tolerated by the users and the hospital staff due to

the expected benefits from the sub-projects being implemented.

http://www.hsep.lk/


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12. INSTITUTIONAL ARRANGEMENTS AND TRAINING

31. PMU and PIU with the involvement of consultants such as social safeguard expert, gender

expert and RDC are responsible to monitor implementation of social safeguard requirements

(SSR) under the project. ADB has provided general training for PMU and PIUs staff

implementation of social safeguard requirements. The social safeguard specialist and gender

expert are involved in implementation and monitoring of SSR and GAP providing more

guidelines and training for project staff. The formal training program planned to be conducted

got delayed due to prevailing COVID 19. However, the social safe guard expert used the

opportunity of his visits to sub-projects to provide social safe guard related information to the

Design and construction supervisory staff, contractors and hospital staff. These are informal

interventions and therefore, formal awareness program will be held in immediate near future as

soon as country becomes normal with the withdrawal of currently imposed travel restrictions.

12.1 - COMPLY WITH STANDARD ADB SAFEGUARDS IN REHABILITATION AND CONSTRUCTION

32. Outreach to contractor and laborers:

a. Each PIU with the guidance of PMU and other consultants such as gender experts have

conducted training for PIU staff contractors and hospital staff to address and avoid or

minimize public nuances and other inconvenience during construction period of the project.

b. Awareness and implementation of occupational health and safety guidelines and

practices, for example, use of hard hats and protective gear. Under the supervision

of consultants and M&E officers regularly visit and monitor construction safeguard and

Environment safeguard. During the field visits in January and April 2021 the Social

safeguard expert found workers in construction sites follow typical construction related

safety measures and also additional health measures recommended to prevent from

COVID 19.

c. Child labor: the SPS employs a zero-tolerance policy for child labor, as such, it is

imperative that all sub-contractors (formal and informal) comply with this edict. Sri

Lankan labor law supports this caveat.

d. Fair wages for men and women: The contractors in each sub project maintain worker register for

both formal and contract staff. According to the informal discussion of the social safeguard expert

with men and women workers in construction site, they both receive similar wages. Even though

there are no documents to prove gender buyers remuneration related dis-remunerations are not

observed.


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12.2 - MEASURES TAKEN FOR THE CONTAINMENT OF COVID -19 SPREADING THE PROJECT SITES

33. According to the guidelines provided by ADB, PMU has onducted special awareness programs

for monitor construction sites and workers. Special monitoring formats developed and monitoring

has been conducted by PIUs. All PIUs have taken responsibilities for make sure contractors

precaution action related to COVID 19

34. Summary of the recording and monitoring the procedures adopted by the contractors during 2020

to ensure health and safety to prevent spreading of COVID-19 is mentioned in table 5. Similar

monitoring program with relevant to actions was carried out during 1st 6 months of 2021 with regard

to measures to be taken for mitigating COVID-19 related possible implications. Further, lessons

learned during 2020 were effectively used for planning and implementation of an enhanced program

during 2021. The social safeguard expert observed same guidelines were being followed in

construction sites he visited in January and April 2021.

Table 5- Procedures adopted by the contractors and action taken with regard to COVID 19

Procedures adopted by the contractors Action taken

1. What activities were considered when

reopening the sites?

a. Reopening of sites and mobilizing the

workers

b. Awareness creation, routine, and regular

health/ hygienic practices

c. Emergency preparedness

a. Clean the site before the work commenced.

Face masks provided, maintain register for

workers and instruct to maintain social

distance and sanitization. Instructed to bring

meals from home and to eat without sharing.

b. Provide posters included safety measures.

Aware and conduct regular site meetings.

Briefing before work begins, Posters and make

facilities to listen to Radios during working

hours to learn about information related to

COVID.

c. A senior worker has been appointed in each

site as office r in charge in taking action in an

emergency situation of the construction site.


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2.What precautions have been taken so that

workers are not at a risk to expose/infect the

virus

Note: workers at a site near a hospital are

more vulnerable to be infected

Strictly advised to be apart from entering the

ward or visiting near patients and had no

issues as all are well aware after the curfew

period.

3.List out the activities carried out at sites and

(practical) measures that shall be adopted to

contain any infection or spread of disease

Conduct personal surveillance of workers and

strictly maintained a practice of one meter

distance between workers in the construction

site.

4. List out the measures adopted at site to

record the health condition of workers upon

reporting to work and their where about and

specific activities they had got involved during

the lock down period.

At the briefing time Supervisors have been

inquired about the health of the family members

whether they had fever, cough what so ever

and checked the temperature- maintained.

Record book has been maintained to record

down if any changes felt or told

5. List out the measures that would be adopted

to monitor the health condition of the worker

force. Note that workers/ staff with following

conditions should not be allowed to the site.

a. Those having fever, with or without acute

onset respiratory symptoms such as

cough, runny nose, sore throat and/or

shortness of breath

b. Those who have had contact with

suspected or confirmed case of

COVID-19 for the last 14 days

c. Those who are quarantined for COVID-

19

d. If sick person reports for work, he/she is

sent back home immediately

e. Wearing masks has been imposed as a

compulsory condition for the workers.

a. Not reported and supervisor has been not

allowed even to the morning briefing

b. Not reported

c. Not reported

d. Not Reported and had plans to keep

infected worker to not attach to work until a

clear permission granted by Health Officials


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6. Include the procedure/s that will be followed

with respect to managing visitors and other

deliveries to site

Visitors have been restricted (Register Book) to

enter the sites. Boards have been displayed

including visitors cannot enter, if they need to

come in, they have to contact the supervisor

over the phone and if the supervisor is

satisfied, he or she can enter with same

precautions.

7. Include measures taken to provide required

PPE to workers, measures taken to enforce

them to wear them at site and measures used

to dispose the used items such as face masks

Workers must dump the face mask to the

separated dust bin in front of the work

supervisor that he had placed it at the right bin

to dispose.

7. Include measures taken to provide required

PPE to workers, measures taken to enforce

them to wear them at site and measures used

to dispose the used items such as face masks

Workers must dump the face mask to the

separated dust bin in front of the work

supervisor that he had placed it at the right bin

to dispose.

8. List out the routine and regular measures

that would be adopted at sites to maintain the

health, hygiene and safety of the workforce

including office staff (including social

distancing where possible)

Social distancing at work, having meal and

accommodation advised.

9. List on how awareness programmers shall be

conducted for the workforce on spread and

containment of COVID 19. On good health and

hygienic practices and for workers who return

home the precautionary measures they should

be taking. Consider in maintaining physical

distance when conducting awareness

programmers and meetings.

Site supervisor remind preventive measures in

every site meeting


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10. Provide information on how

accommodations, kitchens, meal rooms, labor

billets shall be improved to restrain any

possibility of contamination

Accommodations are temporarily closed at the

sites and most of the workers travel from their

home. Temporary accommodations have been

re arranged under supervision of site supervisor

11. Include procedures that would be adopted in

case an infected persons/ suspected case is

found at site

Proposed procedures - Inform PDHS and to the

contractor to take immediate action to send the

effected person to quarantine and to set others

to be in self-quarantine till the PCR test are done

repeatedly to ensure that they are totally cured.

12. Has the Contractor or site supervisor consulted the Medical Officer of the healthcare facility (of the sub-project) before reopening, and what were the opinion/advice obtained? Contact the medical officer and record his/her opinion on site organization and health & safety plans to prevent COVID-19, and safeguard general health of the workers.

No formal discussions with Medical Officers or

other related officers, sites are opened

according to the general information made to

the general public and the other institutions.

None of the subproject in 4 provinces was

no t identified as COVID affected

construction site.

Source: PMU, PIU, contractors, social and environmental safeguard expert

The social safeguarded expert also observed the covenants introduced as per legal agreements to be

followed in construction sites. The details of covenants and states of compliance of the contractors

and other parties of the project are shown in table 6


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12.3 - Social Safeguard Covenant

The social safeguarded expert also observed the covenants introduced as per legal agreements to be followed in construction sites. The

details of covenants and states of compliance of the contractors and other parties of the project are shown in table 6

Table 6 - covenants - as per legal agreements

No. Shed Para No.

Description Remarks/Issues

Loan 3727

4 5 Involuntary Resettlement and Indigenous Peoples

The Borrower through the Project Executing Agency shall ensure that the Project does not have any indigenous peoples or involuntary resettlement impacts, all within the meaning of ADB’s Safeguard Policy Statement (2009). In the event that the Project does have any such impact, the Borrower shall take all steps required to ensure that the Project complies with The applicable laws and regulations of the Borrower and with ADB’s Safeguard Policy Statement.

Complying Any location which requires land acquisition and involuntary resettlement is not considered under the project to build facilities.

No resettlements and Plans are required and follow the ADB s safeguard Policies.

Loan 3727

4 6 Human and Financial Resources to Implement Safeguards Requirements

The Borrower shall make available or cause the Project Executing Agency to make available necessary budgetary and human resources to fully implement the respective EMP.

Complying

Loan 3727

4 7 Safeguards – Related Provisions in Bidding Documents and Works Contracts Complying


Page | 18

The Borrower through the Project Executing Agency shall ensure that all bidding documents

and contracts for Works contain provisions that require contractors to:

(a) comply with the measures and requirements relevant to the contractor set forth in the respective IEE and EMP (to the extent they concern impacts on affected people during construction), and any corrective or preventative actions set out in a Safeguards Monitoring Report;

Safeguard monitoring carried out and GRCs established

IEE and EMP are attached to the civil works bid documents for implementation by constrictors

Loan 3727

4 7 (b) make available a budget for all such environmental and social measures; and Complying

Loan 3727

4 7 (c) provide the Borrower with a written notice of any unanticipated environmental, resettlement or indigenous peoples risks or impacts that arise during construction, implementation or operation of the Project that were not considered in the respective IEE or EMP.

Complying

EMP is being implemented by contractors and monitored by PMU and PIUs. No resettlement or IP impact is found during the construction in 2021 first six months

Loan 3727

4 8 Safeguards Monitoring and Reporting

The Borrower through the Project Executing Agency shall do the following:

(a) submit semi-annual Safeguards Monitoring Reports to ADB and disclose relevant information from such reports to affected persons promptly upon submission;

First six months 2021 report

Loan 3727

4 8 (b) if any unanticipated environmental and/or social risks and impacts arise during construction, implementation or operation of the Project that were not considered in the respective IEE or EMP, promptly inform ADB of the occurrence of such risks or impacts, with detailed description of the event and proposed corrective action plan; and

Complying

Action taken for issues will be informed to ADB

Loan 3727

4 8 (c) Report any actual or potential breach of compliance with the measures and requirements set forth in the respective EMP promptly after becoming aware of the breach.

Complying

Loan 3727

4 9 Prohibited List of Investments

The Borrower through the Project Executing Agency shall ensure that no proceeds of the Loan or Grant are used to finance any activity included in the list of prohibited investment activities provided in Appendix 5 of the SPS.

Complying

Loan 3727

4 10 Labor Standards, Health and Safety

The Borrower through the Project Executing Agency shall ensure that the core labor standards and the Borrower’s applicable laws and regulations are complied with during Project implementation. The Borrower shall include specific provisions in the bidding documents and contracts financed by ADB under the Project requiring that the contractors,

Complying

Contractor responsible for Laws and regulations for labor standard


Page | 19

among other things: (a) comply with the Borrower’s applicable labor law and regulations

and incorporate applicable workplace occupational safety norms; (b) do not use child labor; (c) do not discriminate workers in respect of employment and occupation; (d) do not use forced labor; (e) allow freedom of association and effectively recognize the right to collective bargaining; and (f) disseminate, or engage appropriate service providers to disseminate, information on the risks of sexually transmitted diseases, including HIV/AIDS, to the employees of contractors engaged under the Project and to members of the local communities surrounding the Project area, particularly women.

HIV/AIDS awareness programs was conducted by PIU within first quarter 2020.

Loan 3727

4 11 The Borrower shall strictly monitor compliance with the requirements set forth in paragraph 10 above and provide ADB with regular reports.

Complying

Any labor issue will be included in the QPRs

Loan 3727

4 12 Gender and Development

The Borrower shall ensure that (a) the GAP is implemented in accordance with its terms; (b) the bidding documents and contracts include relevant provisions for contractors to comply with the measures set forth in the GAP; (c) adequate resources are allocated for implementation of the GAP; (d) progress on implementation of the GAP, including progress toward achieving key gender outcome and output targets, are regularly monitored and reported to ADB; and (e) key gender outcome and output targets include the following:

Complying Gender Specialist will be recruited for implementation and monitoring of GAP, and was appointed in February 2020

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13. CONCLUSION AND RECOMMENDATIONS

35. It has been found that no additional land is required for most of the subprojects. The land identified for locating all facilities

are belong to respective institutions without acquiring private lands except the subproject in Uyanwatta of Kegalle district. The

land identified for Uyanwatta subproject was a private property donated to the regional health department in Kegalle. At present

some issues related to land ownership has immerge and there being attempted at seeking solutions. Except this case there were no

resettlement impacts or temporary disruption of livelihood of any household or group of community in the project area during

design and construction periods were observed. Hence, it can be concluded that the project activities conducted during the

reporting period does not have any involuntary resettlement issues. Nevertheless, Sub-project, Uyanwatte PMCU in Kegalle

got delayed in awarding contract due to some legal issues of the land. This issue has been identified in a study conducted by

Social safeguard expert and action will be taken by the provincial health Authorities to clear the land from its legal issues. The

Uyanwatte sub-project in Kegalle will be implemented after clearance of the land related issue.

36. Therefore, the findings of this Social Safeguard Monitoring Report confirm the finding of DDR, as per ADB Safeguard

Policy Statement, the project have been categorized as ‘C’ for both Involuntary Resettlement and Indigenous Peoples.

There is no permanent or temporary disruption of livelihood of any household or group of community in the project area

during construction period in first six Months in 2021. Therefore, the report not found significant reasons for changing

categorizing of the project.

37. PMU and PIUs provide details of necessary building requirements to contractors to meet ADB Social Safeguard guidelines

to avoid issues. Since small contractors are carrying out most of civil works. Further, PMU and PIUs will provide an

awareness program for contractors on ADB social safeguard requirements.

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14. ACTIVITIES PLANNED UNDER SOCIAL SAFEGUARD COMPONENT OF THE PROJECT

38. The activities social safeguard experts plans to attend during second 6 months of 2021 are summarized in table 7

Table 7 – Activities planned in the 2nd 6 months of 2021

Activity Details Time plan

Social safe guard awareness program

Formal training session will be conducted in each province with the participation of PIU relevant staff, Key actors of contractors, Representatives of Design preparation and construction supervisory staff, Medical doctors of sub-projects under round 2

From August 2021 to October 2021( intermittent inputs)

Preparation of DDR for subprojects under round 2

Each subproject will be studied to prepare DDR

Preparation of DDR will be continued from August 2021

Sample studies/case studies with subprojects already completed in each province under round 1

This study will focus on lessons to be learned on social safe guard and other social impacts for replication in other subprojects within HSEP and else where

This was done in first six months of 2021 but it will be further continue from August 2021

Preparation of ADB and client required reports

Quarterly, bi-annual and annual reports and final report on the HSEP

At the time of requirement


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Annex 1- Detailed observation of field visits during January to June 2021

Table 8- Observations in subprojects visited during in January 2021 – Monaragala district

Name of subproject

Socio economic features Need addressed by subprojects

Issues observed

Kotiyagala PMCU (Round 2: stage 2)

Located in 124H Kotiyagala GND, of Siyambalaanduwa DSD, the people in Wattegama, Karakolapitiya, Kotiyagala, Biloya, Pahantarawa people this area used to visit this hospital for treatment. Most of them are farmers involved in rain fed cultivation during Maha season. Therefore, majority of these beneficiaries of this hospital area categorized as poor and economically vulnerable community. The nearest hospital for this group other than Kotiyagala is at Athumalai. They have transport difficulties to visit hospitals such as Athumalai, Siyambalaanduwa and Monaragala. This hospital is reach by about 100 persons’ average for various treatments in OPD. Human elephant problem is a serious issue for free mobility of these poor farmers.

The design for the subproject has been prepared and shown to the hospital staff for their comments. Hospital staffs are of the opinion that proposed designed will addressed most of the existing problems in the PMCU. The existing problems include lack of space, dilapidated toilet systems, lack of facilities for medical doctors and rest of the staff, non-availability for space for dental treatment and storing drugs. Non availability of good quality drinking water

Hospital staff did not raise any social safeguard issues, but they prefer if water related problems are solved. It was observed there is flexibility in the design for separation of large area in the new building for different purposes according to the desires of the hospital staff. Non-availability of regular service of medical officers has been serious issue in this hospital for a long period of time.

Buddama PMCU Monaragala

This is located in Siyambala anduwa DSD. The people from Meeyagala, Ambagaspitiya, Ritigahawatta, Ketagoda, Kuppebedda, Kirawanaberaliya and Gowindapura vistis these hospital for treatment. These people have to visit Siyambalaaanduw hospital if the facilities are poor in this PMCU. At least 200 people

Lack of space for deliveing better services if the main constrain. There are no conducive infrastructures inside the existing building for clinics. No ETU facilities, no place for dental treatment. There is no specific place for drug storage. Medical officer has quarters for residential facility but other staffs do not have. They also travel

Most of the existing problems will be addressed by the proposed designed but heir worried about good drinking water facilities and also a separate pantry for at least to prepare tea for the staff and ambulance with a garage.


Page | 23

per day visit this PMCU for treatment. Most of the community members coming for treatment are farmers.

from faraway places with difficulties. Toilet system is badly dilapidated.

Bakinigahawela PMCU - Monaragala

The existing building is located in a small land block that has significant limitation for expansion. Some limited extension is possible in the backyard of the existing building and therefore, proposed subprojects will be confined to the backyard of the premises. Drinking water facilities is available.

The hospital staff could not be contacted during these visits but few community members in the vicinity informed the existing difficulties mainly due to inadequate space for OPD, holding clinics and other facilities such as adequate space for medical officer, other staff and also some place for their resting requirements.

The design team has understood this difficulty due limited space in the land block, expansion will be carried out in the backyard but there may be need to remove a stone in that bear land area. However, need for the improvement is whittle to enhance the services to the neighboring community mainly depending on agriculture.

Devathura PMCU - Monaragala

This hospital located in Devathura GND of Badalkumbura DSD. The beneficiary’s area mainly farmers residing in GNDs such as Devathura, Bibilegama and few other GNDs. About 8 to 900 patients reach the hospital in some days for treatment for OPD and attained clinics. There mainly agricultural community. Transport is the most difficult to reach the hospital. In this case community in the area are much interest to get hospital to avoid next hospital located about 8 to 10km away from their residences (Namunukula hospital) Hingurukaduwa district hospital is located in 15km distance from Devathura. Wellawaya main hospital is also 40km away from

Existing building is in limited land plot (66 perch). Therefore, proposed designed is confined to small land plot. Inadequate facilities for OPD related activities will be addressed by the proposed project. Water for the hospital is taken from community water supply project. The hospital staff are happy about the proposed expansion that will address the main problems related to inadequate space. Even after the implementation of proposed subproject dilapidated doctors’ quarters and lack of even a small pantry for preparing tea for the staff will remain and medical staff intend to take up these issues with the provincial health authority


Page | 24

Devathura. Significant number of Tamil community also benefit from this proposed subproject. This Tamil community involve in tea plantation activities in the vicinity.

Occampitiya divisional hospital

This divisional is located in Buttala in Monaragala district. Most of the beneficiaries’ communities are farmers and labouers in gem mining. Beneficiary people living interior areas are having serious transport difficulties. Considerable number of people from outside of Occampitiya involved in illegal gem mining also visits the hospital even in odd times. A larger area in Buttala DS covers in this hospital for treatment some of the GNDs located in this large area include Galatemmennawa, Neardella, Mahagodayaya, Gaminipura, Gonaketiya, Suduwaturawa, Pahalagama, Buruthapolla, Urulugoda and Malikawila. Some of the facilities such as ETU dental clinic have been rehabilitated two years ago.

Even though few facilities have been recently rehabilitated. This hospital needs improvements to addressed the problems due to inadequate facility in OPD area, consultation rooms, ETU, area for clinics and some wards (at present ETU and two wards have been proposed for rehabilitation under provincial funds. Rest of the needs will be addressed by the proposed ADB funded subprojects.

Issues related to social safeguard were not observed. The medical staff interviewed pointed out even after implementation of ADB funded project the issues such as water treatment, space for keeping available generator, repairs of Medical Officer and other quarters will remain. They also pointed out residential facilities for nurses and other health workers are critical needs due to travelling in risk roads with human, elephant’s conflicts.


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Table 9 - persons consulted – Monaragala District

Subproject Persons consulted

Kotiyagala PMCU in Monaragala K M Madara Chrishanti – Dispenser PH: 0783760391

K M Sunitha Kumari – health service assistant PH:

0787645814

K A Saudiga – farmer in Kotiyagala

M D Jayasena – farmer in Kotiyagala

Dr Samitha Lakshman – Medical Officer.

M A Premalatha – temporary health service labourer

Buddama PMCU Monaragala Aravind Batuwanthudawa – Medical officer,

A. A. Lakmali Amarasooriya – Dispenser

P. M. Damayanthi – development officer

I A G A Attanayake – Driver

G M Chamila Priyadarshanie – labourer

P M I Pushpakumara - Labourer

S P Priyantha - labourer

Devathura PMCU - Monaragala Dr. Mrs. G B S Dayaratna Medical Officer

D M A P Jayasundra - Dispenser

R M S M Ratnayake – storekeeper

R D Tennakoon – minor staff

Occampitiya divisional hospital Dr. Nandasiri – Medical Officer

S.G.A. Pushpasiri – nursing in charge

R M Nilupa Kumari – health assistant.


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Table 10 - Observations in subprojects visited during in April 2021 – Matale district

Name of subproject

Socio economic features

Need addressed by subprojects

Issues observed

Paldeniya PMCU

This PMCU is located in Pallepola DSDs. Rural community living in Mahawela , Paldeniya and Polwatta GNDs visit this hospital. Most of the beneficiaries are agricultural community involved in plantation work.

The subproject is in progress and it will be addressed most of the existing issues of the PMCU. New design includes ETU, Minor laboratory, drug store, consultation rooms for Medical officers, improved toilets system for patients and doctors. Separate place for dressing and clinics. Water for the hospital is provided by the Pradesiya Saba, but quality of water is not goods and hospital staff get drink water from outside for mixing of medicines and for drinking purposes of the staff

Significant issues on social safeguard were not observed. Access to improve the PMCU is a significant problem. The hospital staff interested to take this issue to the Pradesiya saba. They also need to take the drinking water issues with same institution. In overall ongoing subproject has introduced significant infrastructures facilities to enhance the service of the PMCU.

Kalundewa PMCU

Kalundewa PMCU is located in Dambulla DSD. The nearest hospital to is Dambulla base hospital. According to the medical staff, farmers even from Dambulla visit this hospital mainly due to comfortable and flexible access to hospital and its staff. In this context it is expected increase of patient treated per day from 15 to 20 up to 70 per day. The number of patients during land preparation period of paddy lands are extremely low but it gets increase significantly just

Quarters belongs to midwife of MOH is used as PMCU at present. Therefore, it has extremely poor facilities to function as medical treatment center. Both medical staff and patients have difficulties during treatment time due to congested area. at present other facilities such as ETU for emergency use, facility for nebulization if need, waiting area and all other treatment area are confine to one location. In most of the time patients are completed to

Most of the present difficulties in PMCU will address by the proposed subprojects. The medical staffs are after opinion that the human resources of the center should be significant increase to enhance the services in improved hospital.


Page | 27

after that preparations. wait outside the building and they have difficulties during rainy days. Other essential facilities such as drug stores, dressing area are not available.

Sigiriya Divisional Hospital

This is fairly large hospital with multiple buildings established for different services at least 150 patients get treatment from OPD. The hospital also has facilities for residential treatment. The hospital is located in tourist area but majority of beneficiary community members are famers.

Inadequate OPD non availability of laboratory facilities, dilapidated and poor sanitary system, inadequate facilities for medical staff, lack of space for drugs store, ETU has space related issues are the present problems in the hospital. These problems will get satisfactory addressed by the proposed designed of subprojects.

Medical staff proposed access facilities to improve between its ETU and main building. Apart from improving the buildings for the hospital medical staff suggested to improve their residential quarter and also to construct additional quarters for medical officers.

Galewela Divisional Hospital

This is one of the moderate the large divisional hospital in Dambulla area. It covers about 5 DSDs in Central province for treatment. According to the medical staff at least 300 patients come to OPD and other 250 come for clinic. In an average day about 20 indoor patients are observed. These patients are coming from larger catchment including Galewela, Ibbagamuwa, Kekirawa, Dammbulla and Pallepola. Hospital has five different wards. And fairly large medical staff but inadequate for enhance service

The main activity under the ADB funded project is rehabilitation of existing dental treatment center. The functions of dental treatment will be transferred to another building in the main hospital area. The new building used for expanded outdoor patient treatment and holding different clinics.

After improvements under the proposed subproject, human resources also to be increase to provide enhance services. The medical staff also highlighted some other needs to be addressed in the hospital with funding facilities from other sources. These needs include establishment of x-ray facilities, installation of a generator and mini operational theater.

Madawala Ulpotha PMCU

Even though this is a primary health care center average 150 patient come for treatment in OPD. Another about 80 patients

The present main problem is inadequate space. The present buildings are seriously dilapidated. There are no facilities such as drug

The medical staffs are satisfied with the proposed designed they after view that service can enhance significantly


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for clinics. Two clinics are held per week. People from large catchment use to come for this hospital for it are easy access and environment. Most of these patients are rural farmers from DSDs such as Matale, Yatawara and Pallepola

stores, holding clinics with safety and inadequate waiting area for the patients. The medical doctors had proposed complete demolition of existing buildings but only renovation has been approved under the subproject. But renovated building with modification will have most of the facilities.

Table 11 - Persons consulted 2021 – Matale district

Subproject Persons consulted

Paldeniya PMCU Dr. Namal Edirisinghe – Medical Officer

M Sandun Stanley - Worker

H P A P Abeyratna - Dispenser

M Dahapala - farmer

Kalundewa PMCU Dr. Manoj Galgamuwa – Medical Officer

Sigiriya Divisional Hospital Dr. Mrs Nilukshi – Medical Officer

Mr. Nishantha – Nursing officer

Galewela Divisional Hospital I G Rupasinghe – nursing oficer

S M Premaratna – In charge of minor staff

Dr. W. J. Ratnayake - DMO

Madawala Ulpotha PMCU Dr. R M K Ratnayake – R M O

Dr Imali Walpola – Medical officer


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Table 12 - Observations on Kegalle District during April 2021

Name of subproject

Socio economic features Need addressed by subprojects

Issues observed

Uyanwatta PMCU

Rural community with multi ethnic groups, mobility in the interior area is difficult due to narrow and dilapidated road system. Most of the community members are rural farmers depending on minor export corps.

Improvement to OPD, establishment of ETU and construction of proper sanitary toilet system.

This sub project was suggested for improvement under round 1 but due to some problems with the legal ownership of the land civil works could not be commenced.

Hewadhiwela PMCU - Kegalle

This PMCU is located in Rabukkana DSD. The rural community in GNDs such as Siyambalagamuwa, Kudagama, Alugolla, Deliwela, Meepagoda, visits for treatment. The existing building of the hospital has been constructed in community sport ground but the users of the ground themselves have requested the subproject for improving existing facilities. Most of the community members visiting are farmers. The visitors find serious access difficulties due to non-availability of public bus service up to the hospital. Therefore, beneficiary visitors are compelling to travel in mainly 3wheelers.

The existing building has serious space related difficulties. The work in OPD could not be performed effectively due to this problem. The facilities such as ETU, drugs store, space for holding clinics and reasonable sanitary toilet system were not available. The new building which has been completed now has enough space to establish these facilities at reasonable level. The new building for the hospital will be open in near future.

The hospital staff and the leaders of community base hospital of Hewadhiwela are much satisfied with the new building constructed. The hospital staff expect provincial level health authorities to consider increasing human resources in the hospital for enhanced services in the new building. Issues related to social safeguard were not observed during construction phase of the new building.

Bolagama PMCU - Kegalle

This PMCU is located in Rambukkana DSD. The rural community from GNDs such as Kiriwandeniya, Bolagama, Meemana, Kiulpana, Muwapitiya, Ratnampitiya, Pinnawela, Kotagama visit the PMCU for treatment, mainly in OPD and clinics. About 60 to 100 patients visit the hospital for treatment in OPD. The hospital is located

Most of the issues related to inadequate space have been addressed by the new subproject. The hospital staff have flexibility to use the larger area constructed as OPD depending on their service requirements. The new sanitary latrine with

Issues related to social safeguard were not observed during the construction period. Nevertheless, hospital staff are of the view that health authority in the province should provide equipment to the new building to use for enhance services.


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in a place it can be easily access through public bus service. Water supply was the main problem in the existing hospital. The PMCU is significant mainly for the poor rural community because if this service is not available, they have to visit other hospital which are more than 7km away from this PMCU (Rambukkana, Mawanella and Kegalle)

facilities for male, female and disable are appreciated by the hospital staff. The room indicated in the designing as ETU may be used as dressing room according to the hospital staff. The most significant problem solved by the subproject is drinking water provided through tube well.

Aranayake Divisional Hospital – Kegalle

Aranayake Divisional Hospital is one of the ancient hospitals in the country constructed during British period. This hospital is located in a large land block in extent of 4acres. The hospital provides routing services to large number of patients, for example 400 per day in OPD, about 200 per day in each clinic, 16 clinics are held in a month. Atleast 40 patient get admitted day for in-house treatment.

The HSEP under its need assessment of each cluster a new building for the hospital has been built. The hospital staff appreciate the additional infrastructure added to the hospital. Some of the activities presently performing in existing buildings can be shifted to the new building. Almost all the existing buildings are presently dilapidated even though they are being used. For example, all the wards, kitchen, staff quarters are in need of immediate rehabilitation. Water supply to the hospital is not in good condition for drinking. There is no facility for sustainable waste disposal.

But hospital staff need to get other dilapidated buildings repaired with the possible support from provincial health authority in Sabaragamuwa province

Minuwaragama PMCU -

Minuwaragama PMCU located in Kegalle DSD. It is

The main problem of existing building is

There were no serious social safeguard issues


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Kegalle about 6km from Kegalle township. The nearest private care unit of Minuwaragama is Wakirigala, it is about 8km away from this PMCU. The existing PMCU is a building previously used as village court during British period. Therefore, it has serious drawbacks to be used as medical treatment center. Even though it is being used

inadequate space to be used as OPD and holding clinics. The building is also seriously dilapidating at present it has no proper sanitary latrine system, no place to keep drugs safely. Cats and rats both getting to the inside of the building during night. The staff of the hospital are much happy about the intervention under the health sector project to shift existing PMCU to the new building. New building would address most of the problems and experience at present.

immerge during the construction. The staff are of the opinion that they have to do internal separation within OPD area of new building to create essential facilities such as place of dining, rest rooms and a place to prepare tea for the staff with the consultation of PIU staff in Sabaragamuwa province.

Table 13 - Persons consulted 2021 – Kegalle district

Name of the hospital Persons consulted

Hewadhiwela PMCU - Kegalle Dr. Champa Dilrukshi Jayathilake - MO

Bogika Ariyabandu – Midwife

Bolagama PMCU - Kegalle MO, Midwife and Health worker

Aranayake Divisional Hospital – Kegalle DMO and all other MOs,

nursing development Officer

few health assistants

Minuwaragama PMCU - Kegalle Mr Athula Kemaratna – RMO

G D Ranjith – contractor of the new building.

6 persons visited for treatment


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Annex 2- Information provided by M&E officers in each PIU

Province: Central

Table 14 - Social Issues emerged in hospitals/health care centers under round 1

Name of hospital Construction Completed or not

Social issues emerged-Yes/no

If yes type of issues

KANDY DISTRICT

Hataraliyadda DH Completed No

Madulkele DH Not Completed No

Dholosbage DH Not Completed YES Originally planned activities were not possible due to unsuitability of the land. New scope of work has been identified and planned to be implemented in near future.

Galaha DH Completed No

Deltota DH Completed No

NUWARAELIYA DISTRICT

Kotagala DH Not Completed No

Laxapana DH Completed

Nanuoya PMCU Not Completed

Pundaluoya PMCU Completed

MATALE DISTRICT

Kimbissa DHC Not Completed

No

Kalundawa PMCU Not Completed

Madawalaupatha PMCU

Not Completed

Galewela DHB Not Completed

Paldeniya PMCU Not Completed


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Name of hospital Design Completed or not

Social issues emerged on the land to be used for the project -Yes/no


KANDY DISTRICT Pending ADB Concurrence (Not yet award contracts)

Kolongoda DHC

Morayaya DHC

Ambagahapelessa DHC

Hasalaka DHB

Kurunduwatta DHC

NUWARAELIYA DISTRICT

Hanguranketha, DHC

Gonapitiya DHC

Mandaramnuwara DHC

Agarapatana DHC

MATALE DISTRICT

Madipola DHC

Nalanda DHC

Gurubebila PMCU

Leliambe DHC

Elkaduwa PMCU


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Province: North Central Province





Ellawewa:PMCU Completed No

Sevanapitiya:PMCU Completed No

Damminna:PMCU Not Completed No

Ambagaswewa:PMCU Completed No

Horowpathana:DHC Not Completed No

Galenbindunuwa:DHB Completed No

Negampaha:DHC Not Completed No

Konwewa:PMCU Not Completed No

Tittagonawa:PMCU Completed No





Polonnaruwa District

Sinhapura Completed No

Madagama Completed No

Parakrama Samudraya Completed No

Wijepura Completed No

Bakamoona Completed No

Aselapura Completed No

Weheragala Completed No

Attanakadawala Completed No

Mannampitiya Completed No

Jayanthipura Completed No

Aralaganwila Completed No

Anuradhapura District

Ethakada Completed No

Katiyawa Completed No

Labunoruwa Completed No

Andiyagala Completed No

Mahasenpura Completed No

Habarana Not Completed No

Wahalkada Not Completed No

Mahawilachchiya Not Completed No

Ratmalgahawewa Not Completed No

Poonewa Not Completed No


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Province: Sabaragamuwa (Kegalle)





Bolagama Completed No

Hewadiwela Completed No

Aranayaka Completed No

Minuwangamuwa Completed No





Karandupona Completed No

Basnagala Completed No

Pothdenikanda Completed No

Hinguralakanda Completed No

Bulathkohupitiya In Progress No

Dothaloya In Progress No

Daraniyagala In Progress No

Mahapallegama In Progress No

Undugoda In Progress No

Algama In Progress No


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Province: Uva





Construction/Renovation of OPD Building at DH Meegahakiula

Completed No

Construction/Renovation of OPD Building at DH Ettampitiya

Completed No

Construction/Renovation of OPD Building at DH Haldummulla

Completed No

Construction/Renovation of OPD Building at DH Kandaketiya

Completed No

Construction/Renovation of OPD Building at DH Koslanda

Completed No

Construction/Renovation of OPD Building at PMCU Dombagahawela

Completed No

Construction/Renovation of OPD Building at PMCU Daliva

In Progress No

Construction/Renovation of OPD Building at DH Dambagalla

Completed No

Construction/Renovation of OPD Building at DH Thanamalwila

Completed No

Construction/Renovation of OPD Building at PMCU Hambegamuwa

Completed No


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Table 21- Social Issues emerged in hospitals/health care centers under round 2


Social issues emerged on the

land to be used for the project -Yes/no


Round 2 Phase 1 Contracts

Construction/Renovation of OPD Building at DHB Uvaparanagama

Designs completed and constructions ongoing

No

Construction/Renovation of OPD Building at DHB Haputale


No

Construction/Renovation of OPD Building at DHB Metigahathenna


No

Construction/Renovation of OPD Building at DHB Lunugala


No

Construction/Renovation of OPD Building at PMCU Kotagama


No

Construction/Renovation of OPD Building at PMCU Nannapurawa


No

Construction/Renovation of OPD Building at DHB Medagama

Designs completed and works Temporarily stopped because of this hospital selected as Covid 19 treatment center

No

Construction/Renovation of OPD Building at DHC Pitakumbura


No

Construction/Renovation of OPD Building at PMCU Rathmalgahaella

Designs completed and constructions ongoing.

No

Round 2 Phase 2 Contracts

Bakinigahawela – PMCU

Designs completed and Procurement process ongoing.

No

Okkampitiya – DHC Designs completed and Procurement process ongoing

No

Buddama – PMCU Designs completed No


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and Procurement process ongoing

Kotiyagala – PMCU Designs completed and Procurement process ongoing

No

Dewathura - PMCU Designs completed and Procurement process ongoing

No

Kirklis DHC Designs and BOQs completed

No

Uraniya DHC Designs and BOQs completed

No

Galauda – DHC Designs and BOQs completed

No

Spring Valley – DHC Designs and BOQs completed

No

New land selected for construction of PMCU as an alternative to Wewagama DH

Designs completed No (Batalayaya new land)

New land in Bathalaya is being considered for construction of PMCU instead of DH Wewegama which is located in land slide prone area

Udaveriya DHC Designs and BOQs completed

No

Semi Annual Safeguard Monitoring Report

Documents

Transcript of Semi Annual Safeguard Monitoring Report